Annals for Educators - June 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesJune 2023Annals for Educators - June 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202306200 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsAssociation of Low-Dose Colchicine With Incidence of Knee and Hip Replacements. Exploratory Analyses From a Randomized, Controlled, Double-Blind TrialOsteoarthritis is a major contributor to pain and disability worldwide. Inflammation plays an important role in the development of osteoarthritis, and anti-inflammatory drugs may slow disease progression. This exploratory analysis of a randomized trial examined whether colchicine reduces incident total knee and hip replacements.Use this article to:Review the indications for total knee replacement. This In the Clinic article may be helpful. Discuss the methodology of this exploratory analysis. Was it prespecified? Why is it important to distinguish prespecified from post hoc analysis of clinical trials?Review the findings and ask your learners whether they would prescribe colchicine to patients with knee or hip osteoarthritis based on the findings of this study.Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals. A Stepped-Wedge, Cluster Randomized TrialTrials have shown that hospital walking programs improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions. This trial evaluated the effect of implementation of a supervised walking program known as STRIDE on discharge to skilled-nursing facilities, length of stay, and inpatient falls.Use this article to:Discuss with your learners why getting patients to walk while hospitalized is important.Review the methods of this study. What is a stepped-wedge cluster trial? Why was this methodology used in this study?Review the results of the study. Based on these results, ask your learners whether they think a supervised walking program should be developed at your institution.Distributional Cost-Effectiveness of Equity-Enhancing Gene Therapy in Sickle Cell Disease in the United StatesDistributional Cost-Effectiveness: Putting Money Where Your Mouth Is on Health EquityGene therapy is a potential cure for sickle cell disease (SCD). Conventional cost-effectiveness analysis (CEA) does not capture the effects of treatment on disparities in SCD. This study compared gene therapy versus standard of care in patients with SCD by using conventional CEA and distributional CEA, the latter of which gave extra credit to interventions with measured effects on reducing health disparities. The accompanying editorial discusses the findings and the need to raise the profile of this methodological approach.Use this article and the editorial to:Review currently available therapy for SCD with your learners. This In the Clinic article may be helpful. Discuss how distributional CEA differs from traditional CEA. What are the advantages and disadvantages of each method?A commonly used threshold for cost-effectiveness is less than $100,000 per quality-adjusted life-year gained. Ask your learners whether they think this is a reasonable threshold in the United States. How about in less affluent parts of the world?Comparison of Hospital Outcomes for Patients Treated by Allopathic Versus Osteopathic Hospitalists. An Observational StudyEqual and No Longer Separate: Examining Quality of Care Provided by Osteopathic and Allopathic PhysiciansThe United States has 2 types of institutions that educate physicians: allopathic medical schools, which award MD degrees, and osteopathic medical schools, which award DO degrees. This study examined whether the quality and costs of care are similar for allopathic and osteopathic hospitalists who care for elderly patients hospitalized for 3 common conditions. The accompanying editorial discusses the findings and the increasing similarity of osteopathic and allopathic education.Use this article and the editorial to:Ask your learners if they went to an allopathic or osteopathic medical school. Discuss the current differences between the 2 types of education.Ask your learners whether the findings of this study are what they would have expected.Discuss whether there are clinical situations in which the quality of care provided by physicians with osteopathic versus allopathic education differs.Discuss whether there appears to be any bias against osteopathic education among the leadership at your institution.Effectiveness of COVID-19 Treatment With Nirmatrelvir–Ritonavir or Molnupiravir Among U.S. Veterans: Target Trial Emulation Studies With One-Month and Six-Month OutcomesInformation about the effectiveness of oral antivirals in preventing short- and long-term COVID-19–related outcomes in the setting of Omicron variant transmission and COVID-19 vaccination is limited. This article summarizes 3 retrospective target trial emulation studies that sought to measure the effectiveness of nirmatrelvir–ritonavir and molnupiravir for outpatient treatment of COVID-19.Use this article to:Review the methodology of a target trial emulation. Discuss the advantages this method has over traditional observational study methods.Review the absolute and relative effects of each therapy demonstrated in this study.Ask your learners to describe the clinical situations in which they would prescribe antivirals for a person with acute COVID-19.Invite a pharmacist to your session to discuss the processes for prescribing antivirals for COVID-19 now that the United States has declared an end to the public health emergency.Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease. A Systematic Review and Meta-analysisGuidelines from the United States and Europe differ on the initial recommended diagnostic test strategy for suspected stable coronary artery disease (CAD). This study compared the effects of initial diagnostic strategies (invasive angiography, computed tomography angiography, and noninvasive functional tests) for patients with suspected stable CAD on direct health outcomes and clinical management outcomes.Use this article to:Watch the brief video summarizing the review with your learners. Invite a cardiologist to your session to discuss the diagnostic strategies for stable CAD that are most often implemented at your institution.Discuss the advantages and disadvantages of each diagnostic strategy.Based on the findings of this review, ask your learners what strategy they think is optimal.Improving COVID-19 Disease Severity Surveillance Measures: Statewide Implementation ExperienceMeasurement of the burden of COVID-19 on U.S. hospitals has been an important element of the public health response to the pandemic but is not standardized across facilities. This study examined the effects of adding a proxy indicator of COVID-19 disease severity to state-level mandated reporting of the number of patients hospitalized with COVID-19.Use this article to:Invite the person who leads infection control at your institution to your session to discuss the methods used at your institution and in your state to report COVID-19 hospitalizations.Ask your learners to discuss whether COVID-19 monitoring is important now that the pandemic is no longer a public health emergency.Discuss how the addition of a proxy indicator of disease severity might improve surveillance.Ask your learners if there are measures other than dexamethasone use that could improve COVID-19 surveillance.Beyond the GuidelinesHow Would You Manage This Patient With Recurrent Diverticulitis? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterAcute diverticulitis is a common medical condition that may occur repeatedly in some persons. In this article, 2 gastroenterologists with expertise in acute diverticulitis debate computed tomography scanning for diagnosis, antibiotics for treatment, colonoscopy to screen for underlying cancer, and elective surgery to prevent recurrent disease.Use this article to:Watch the patient video with your learners, and then ask them what they would recommend for this patient with recurrent diverticulitis.Review the American College of Physicians' clinical guidelines ( here and here) for the diagnosis and treatment of diverticulitis. Watch the grand rounds video with your learners, and then have them test their knowledge by taking the quiz that accompanies the article.DyslipidemiaDyslipidemia is an important risk factor for coronary artery disease and stroke. Long-term, prospective epidemiologic studies have consistently shown that persons with healthier lifestyles and fewer risk factors for coronary heart disease, particularly those with favorable lipid profiles, have reduced incidence of coronary heart disease. Prevention and sensible management of dyslipidemia can markedly alter cardiovascular morbidity and mortality.Use this article to:Discuss the tests that are routinely used to diagnose dyslipidemia.Ask your learners when they would order lipid testing in a person who has no history of or symptoms suggesting cardiovascular disease.Review the indications for lipid-lowering therapy as primary prevention.Have your learners test their knowledge by taking the quiz that accompanies the article.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics June 2023Volume 176, Issue 6 ePublished: 20 June 2023 Issue Published: June 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...